A task-sharing intervention for prepartum common mental disorders: Feasibility, acceptability and responses in a South African sample

Spedding, Maxine F.; Stein, Dan J.; Naledi, Tracey; Myers, Bronwyn; Cuijpers, Pim; Sorsdahl, Katherine

doi:10.4102/phcfm.v12i1.2378

Cited by 17 publications

(15 citation statements)

References 42 publications

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“…We selected a South African model of brief Problem Solving Therapy (PST) (36) as the intervention to be adapted for the Ethiopian context for several reasons. These included the problem-orientated nature of stakeholders' perceptions of Ethiopian women's psychosocial distress in primary care (26), the association of perinatal depression with impaired problem-solving and coping (27), and the simplicity and acceptability of the therapeutic model for a low literacy population (37)(38)(39)(40)(41).…”

Section: Pre-adaptation Work To Select and Model The Interventionmentioning

confidence: 99%

Adapting brief problem-solving therapy to improve health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Bitew

Keynejad

Myers

et al. 2022

Preprint

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Background: Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, adaptation of such interventions for low and middle-income countries has not been prioritized. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. Methods: We employed the Medical Research Council (MRC) framework for development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the Ecological Validity Model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. Results: In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0).Conclusion: Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess feasibility and acceptability of the intervention and its delivery in antenatal care settings.

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Section: Pre-adaptation Work To Select and Model The Interventionmentioning

confidence: 99%

Adapting brief problem-solving therapy to improve health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Bitew

Keynejad

Myers

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…We selected a South African model of brief problemsolving therapy (PST) [36] as the intervention to be adapted for the Ethiopian context for several reasons. These included the problem-orientated nature of stakeholders' perceptions of Ethiopian women's psychosocial distress in primary care [26], the association of perinatal depression with impaired problem-solving and coping [27], and the simplicity and acceptability of the therapeutic model for a low-literacy population [37][38][39][40][41].…”

Section: Pre-adaptation Work To Select and Model The Interventionmentioning

confidence: 99%

“…The third phase is making a plan to address each group of problems, to achieve what the person considers to be the most important things in their life. In meta-analyses, PST has been found to treat depression [40,41]. PST has been found to be effective and acceptable in clinical populations with relatively low levels of education [37,38,42,43].…”

Section: The Nature Of Pstmentioning

confidence: 99%

Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Bitew

Keynejad

Myers

et al. 2022

Pilot Feasibility Stud

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Background Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. Methods We employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. Results In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0). Conclusion Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings.

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“…Over the last decade, task sharing approaches have been increasingly explored as an option to deliver mental health services in South Africa [20]. Examples of these approaches include registered counsellors providing problem-solving therapy in the treatment of antenatal common mental disorders [21], a group-based Interpersonal Therapy intervention for depression delivered by lay HIV counsellors [22], and mental health counselling to patients with chronic disease(s) which was delivered by community health workers. [23] A study in five countries (including South Africa) found that the use of nonspecialist health workers in mental health service delivery was perceived as acceptable and feasible by stakeholders if certain conditions are met including adequate training, the provision of ongoing supportive supervision, and adequate compensation.…”

Section: Introductionmentioning

confidence: 99%

Enabling mental health task-sharing: a collective case study of undergraduate clinical associate training programmes in South Africa

2022

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Background There is a shortage of the human resources needed to deliver mental health services which is likely to be exacerbated by COVID-19. Due to mental health workforce shortages, task-shifting and task-sharing approaches have been implemented in a number of countries. Clinical associates, a mid-level cadre working under the supervision of medical practitioners, could play a role in delivering mental health services but it is not clear if they are adequately prepared. This study explored the mental health curriculum content of the undergraduate clinical associate training programmes in South Africa and the views of key informants of the adequacy of training in mental health. Methods A qualitative collective case study approach was utilised for this multisite study at the three universities in South Africa offering clinical associate degrees. The study consisted of in-depth interviews utilising videoconferencing of individuals involved in each programme and a document review. Thematic analysis of the data was conducted. Results Nineteen interviews were conducted. Mental health formed part of the curriculum in all three programmes with the bulk of the training taking place in the final year of the three-year degree. Facility-based training ranged from two weeks to four weeks with one university only using hospitals with mental health units while two universities used hospitals at which the students were based for the year regardless of potential mental health exposure they would receive. The list of curricula inclusions extended to seldom-seen conditions. The quality of training and supervision appeared site-dependant and only one university set minimum experiential targets. Conclusion There is a basis on which to build the competencies and skills regarding mental health in this cadre. A training model that integrates mental health early in the undergraduate curriculum, focuses on common conditions and those with high disease burden, includes time in a mental health unit, provides facility-based trainers with detailed guidance to improve standardisation, and includes specific experiential targets that are monitored will enhance the potential utility of this cadre.

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A task-sharing intervention for prepartum common mental disorders: Feasibility, acceptability and responses in a South African sample

Cited by 17 publications

References 42 publications

Adapting brief problem-solving therapy to improve health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Adapting brief problem-solving therapy to improve health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Enabling mental health task-sharing: a collective case study of undergraduate clinical associate training programmes in South Africa

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